Medical comanagement has become a mainstay of hospital medicine. Several studies, however, suggest that medical consultation and comanagement may not be as effective as originally anticipated. The expansion of comanagement services has helped fuel massive demand for hospitalists and with it a critical and potentially destabilizing hospitalist manpower shortage. Comanagement may also drive unanticipated consequences such as facilitating surgeon and specialist disengagement and hospitalist career dissatisfaction and burnout. Comanagement services should be developed carefully and methodically, paying close attention to consequences, intended and unintended.